Urinary Bladder Cancer: Causes, Symptoms, Types, Risk Factors, Diagnosis, Treatment and Prevention

Bladder cancer is a common type of cancer that develops in the bladder's cells. The bladder is the hollow, muscular structure in your lower abdomen that stores urine.

The lining of your bladder, known as the urothelium, is where bladder cancer often starts to grow. Urothelial cells are found in both your kidneys and ureters, the tubes that connect your kidneys to your bladder. Urothelial carcinoma can form in the kidneys and ureters, although it most usually develops in the bladder.

Most bladder cancer cases are found when they are still very treatable. Bladder tumors of any stage can, however, return after a successful course of treatment. Because of this, bladder cancer patients typically require follow-up tests for years after therapy.

Causes Of Urinary Bladder Cancer

When bladder cells experience DNA alterations, or mutations, bladder cancer first appears. The DNA of a cell carries directions that guide the cell what to do. When healthy cells die, the alterations instruct the cell to continue to grow and divide quickly. The abnormal cells develop into a tumor, which has the power to enter and destroy healthy body tissue. The abnormal cells may eventually separate and spread (metastasize) throughout the body.

Symptoms Of Urinary Bladder Cancer

A few bladder cancer warning signs and symptoms are as follows:

• Hematuria, or blood in the urine, can make the pee appear bright red or cola-colored, there are times when the urine looks normal but blood is detected on a lab test.
• Unpleasant urination
• Frequent urination
• Back pain

Types Of bladder cancers

Your bladder contains a variety of cell types, some of which can develop into cancer. Depending on the kind of bladder cell that the disease begins to appear in, there are different types of bladder cancer.

These details help doctors choose the treatments that might be most effective for you.

Bladder cancer can take the following forms:

• Cancer of the urothelium: The cells that line the interior of the bladder can develop urothelial carcinoma, also known as transitional cell carcinoma. Urothelial cells in the bladder grow when it is full and shrink when it is empty.
• Cancers can also develop in the ureters and urethra, which are lined by the same cells. The most typical kind of bladder cancer in the US is urothelial carcinoma.
• Squamous cell carcinoma, Chronic irritation of the bladder, such as that caused by an infection or by prolonged use of a urinary catheter, is linked to squamous cell carcinoma. 
• Adenocarcinoma: Adenocarcinoma is a cancerous growth that starts in the cells that make up the mucus-producing glands in the bladder.

Risk Factors Of Urinary Bladder Cancer

Bladder cancer risk factors include the following:

• Smoking: Due to the buildup of dangerous chemicals in the urine, smoking cigarettes, cigars, or pipes may raise the risk of bladder cancer. The chemicals in cigarette smoke are processed by your body as you smoke, and some of them are excreted in your urine. The lining of your bladder may be harmed by these dangerous chemicals, raising your risk of developing cancer.
• Increasing age: Age raises your risk of developing bladder cancer. The majority of bladder cancer cases are seen in patients over the age of 55, even though it can strike anyone.
• Gender: Bladder cancer affects men more frequently than it affects women.
• Exposure to a certain chemical: Your kidneys play a critical role in transporting harmful compounds from your bloodstream to your bladder. Therefore, it is thought that being exposed to specific chemicals may increase the risk of developing bladder cancer. One of the things linked to a higher risk of bladder cancer is arsenic, along with chemicals used to make dyes, rubber, leather, textiles, and paint products.
• Previous cancer treatment: Bladder cancer risk is increased by cyclophosphamide chemotherapy. People who get pelvic radiation therapy for an earlier malignancy are more likely to develop bladder cancer later on.
• Chronic Bladder Inflammation: Squamous cell bladder cancer may be more likely to develop in people who experience chronic or recurrent urinary infections or inflammations (cystitis), such as those who use urinary catheters regularly. Squamous cell cancer and persistent bladder inflammation caused by the parasite disease schistosomiasis are linked in several regions of the world.
• Family or personal cancer history: It is more likely for you to develop bladder cancer again if you have already had it. Even though it is uncommon for bladder cancer to run in families, if a parent, sibling, or child has had the disease in the past, your risk may be increased.
• Family History: A family history of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), raises the risk of malignancies of the urinary system as well as of the colon, uterus, ovaries, and other organs.

Diagnosis  Of Urinary Bladder Cancer

Bladder cancer detection methods and tests include the ones listed below:

• A cystoscopy, or examination of the interior of the bladder with a scope: To perform a cystoscopy, your doctor inserts a thin, narrow tube into your urethra called a cystoscope. The lens of the cystoscope can be used by your doctor to see within your urethra and bladder and examine these organs for illness symptoms. Procedures for cystoscopy can be done in a hospital or a doctor's office.
• Taking a tissue sample for testing (biopsy): A cystoscopy may be used by your doctor to introduce a specialized probe into your bladder and collect a sample of cells (a biopsy) for testing. Another name for this procedure is the transurethral resection of bladder tumor (TURBT). TURBT can be used to treat bladder cancer as well.
• Examining a urine sample using urine cytology: Urine cytology is a procedure where a sample of your urine is examined under a microscope to check for cancer cells.
• Image-based evaluations: Your doctor can examine the structure of your urinary system using imaging techniques like computerized tomography (CT) urogram or retrograde pyelograms.
• During a CT urogram, a contrast dye is injected into a vein in your hand, where it gradually seeps into your kidneys, ureters, and bladder. X-rays are taken during the examination to provide your doctor with a complete view of your urinary tract and to aid them in identifying any potential malignant growths.
• To provide a detailed image of the upper urinary system, an X-ray procedure known as a retrograde pyelogram is used. To inject contrast dye into your ureters during this surgery, your doctor will insert a thin tube (catheter) into your urethra and bladder. After that, when X-ray images are being captured, the dye enters your kidneys.

Evaluating the severity of the cancer

Following a diagnosis of bladder cancer, your doctor could suggest additional tests to see whether the disease has progressed to your lymph nodes or other areas of your body.

Testing could include:

• A PET scan
• MRI.
• A chest X-ray
• CT scan

The results of these tests are used by your doctor to stage your cancer. Roman numerals ranging from 0 to IV are used to denote the stages of bladder cancer.The early stages denote a cancer that has not yet advanced to the muscular bladder wall and is restricted to the inner layers of the bladder. The disease has progressed to distant lymph nodes or organs, which is stage IV, which is the greatest level.

Bladder cancer stage

Bladder cancers are further classified into several kinds based on how the cancer cells appear under a microscope. This is the grade of bladder cancer, and your doctor may refer to it as "low grade" or "high grade":

• Low-grade Bladder Cancer: These highly differentiated cancer cells resemble normal cells more in terms of structure and appearance. Low-grade tumors frequently grow more slowly than high-grade tumors and are less likely to penetrate the muscular wall of the bladder.
• High-grade Bladder Cancer: Poorly differentiated cancer cells have an abnormal appearance and seem to share little in common with tissues that appear to be normal. A high-grade tumor tends to grow more quickly than a low-grade tumor and may be more likely to invade adjacent tissues and organs, including the muscular wall of the bladder.

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Treatment  Of Urinary Bladder Cancer

The kind, grade, and stage of the cancer are taken into consideration, along with your general health and treatment choices, to determine the optimal course of treatment for bladder cancer.

Options for bladder cancer treatment include:

• The malignant cells are surgically removed.
• Intravesical chemotherapy is used to treat bladder cancers that are contained to the bladder lining but are highly likely to spread or return at a later stage.
• When bladder removal surgery is not an option, systemic chemotherapy may be utilized as the main course of treatment to improve the patient's prognosis.
• When surgery is not an option or is not desired, radiation therapy is typically used as the primary means of eliminating cancer cells.
• Immunotherapy is used by the body to fight cancer cells found in the bladder or elsewhere.
• If other therapies have failed to control advanced cancer, targeted therapy may be used. Your doctor and other medical professionals might suggest a mix of therapies. These are some of the bladder cancer treatments:
• Transurethral resection of bladder tumors (TURBT). A treatment known as TURBT is used to detect bladder cancer and remove tumors that are contained in the bladder's inner layers and have not yet spread to the muscle. A cystoscope is used by the surgeon to introduce an electric wire loop during the procedure. The electric current in the wire burns or removes the malignancy. Using a powerful laser is an alternative.
• Because the procedure is performed through the urethra, you won't have any cuts or wounds in your abdomen. As part of the TURBT operation, your doctor may recommend a single chemotherapy injection into your bladder to eliminate any remaining cancer cells and prevent the illness from recurring. After the medication has been in your bladder for a while, it is expelled.
• Cystectomy. Cystectomy refers to surgery to remove all or part of the bladder. During a partial cystectomy, your doctor merely removes the portion of the bladder that has a single malignant tumor.
  • A radical cystectomy involves the complete removal of the bladder along with any nearby lymph nodes. Men who undergo a radical cystectomy typically have their prostate and seminal vesicles removed. During a radical cystectomy, the uterus, ovaries, and a section of the vagina may be removed.
  • A small incision on the lower belly can be used to perform a radical cystectomy with the use of robotic surgery. The surgeon operates the robotic surgical tools with their hands while sitting at a console nearby and doing the procedure.
• Reconstructing a neobladder: A radical cystectomy (urinary diversion) requires your surgeon to create a new route for urine to exit your body. Urine diversion techniques include neobladder reconstruction. Your surgeon crafts a spherical out of a piece of your intestine. Your neobladder also referred to as an internal reservoir, connects to your urethra. Due to the neobladder, most people can urinate adequately. A catheter may be required by some percentage of persons to help in clearing the neobladder.
• Ileal conduit: To create a tube (ileal conduit) for this type of urine diversion, your surgeon uses a portion of your intestine. The tube empties into a pouch (urostomy bag) that you wear on your abdomen after leaving your body through the ureters, which drain your kidneys.
• Continent urinary reservoir: To store urine using a section of the intestine, your surgeon builds a tiny pouch (reservoir) inside your body during this type of urinary diversion surgery. You periodically drain the reservoir of urine through a hole in your belly using a catheter.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. In most cases, bladder cancer is treated with a combination of two or more chemotherapy drugs.

Medication for chemotherapy may be given:

• Intravenously: Intravenous chemotherapy is usually given before bladder removal surgery to increase the likelihood of successfully treating the malignancy. Chemotherapy is a treatment option for cancer that may still be present after surgery. In certain situations, radiation treatment and chemotherapy may be employed.
• (Intravesical treatment) straight into the bladder: Through your urethra, a catheter is put into your bladder during intravesical chemotherapy. The chemotherapy is allowed to remain in the bladder for a specific period before being removed.
• It can be used as the major treatment for superficial bladder cancer when cancer cells only harm the bladder lining and not the underlying muscular tissue.

Radiation therapy

Radiation therapy employs protons and other high-energy beams, including X-rays, to destroy cancer cells. Radiation therapy for bladder cancer is often administered by a machine that moves about your body and directs energy beams at specified areas.

Radiation therapy may be combined with chemotherapy when surgery is not an option or is not desired to treat bladder cancer.

Immunotherapy

There is immunotherapy for:

• Directly into the bladder (intravenous therapy): Following TURBT, intravenous immunotherapy may be beneficial for small bladder tumors that haven't migrated to the deeper muscle layers of the bladder. The tuberculosis vaccine Bacillus Calmette-Guerin (BCG), which is used in this therapy, was developed. An immune reaction brought on by BCG propels cells that fight infection to the bladder.
• The term "intravenously" refers to a vein. Immunotherapy may be given intravenously for bladder cancer that is advanced or that returns after first treatment. There are numerous immunotherapy drugs on the market. These drugs help your immune system find and get rid of cancer cells.

Targeted therapy

Targeted treatment medications focus on specific defects in cancer cells. Targeted drug therapy that concentrates on these weaknesses can destroy cancer cells. Your cancer cells may be analyzed to evaluate whether targeted therapy has a good chance of being effective.

Targeted therapy may be an option if earlier treatments for advanced bladder cancer are ineffective.

Protecting the bladder

People with muscle-invasive bladder cancer should consider trying a mix of treatments if they don't want to have their bladder surgically removed in some situations. The combination of radiation therapy, chemotherapy, and TURBT is referred to as trimodal therapy.

Your surgeon first performs a TURBT procedure to remove the most bladder cancer while preserving bladder function. After TURBT, you have to undergo a regimen of chemotherapy along with radiation therapy.

If, despite trimodality therapy, the cancer has not entirely vanished or if you encounter a recurrence of muscle-invasive malignancy, your doctor may recommend a radical cystectomy.

Bladder cancer may come back even after good therapy. As a result, people with bladder cancer need to have follow-up exams for years after receiving successful treatment. The number and type of tests you undergo will depend on your bladder cancer type, how it was treated, and other factors.

Doctors normally advise having a cystoscopy, a test that examines your urethra and bladder, performed every three to six months for the first few years after bladder cancer treatment. After several years of surveillance without discovering a cancer return, you might only need a cystoscopy examination once a year. Your doctor could frequently recommend additional tests.

Patients with aggressive cancer may get tests more regularly. Those with less dangerous cancers might get less regular testing.

Prevention  Of Urinary Bladder Cancer

Although there is no surefire way to avoid bladder cancer, there are things you may take to lower your risk. For illustration:

• Avoid smoking: If you don't smoke, don't start. Discuss a strategy to help you stop smoking with your doctor if you do. You might succeed in quitting through support groups, medication, and other strategies.
• Take precautions when around chemicals: Keep all safety precautions in mind if you work with chemicals to prevent exposure.
• The fruits and vegetables you choose should be varied: A diet is high in a diversity of fruit and vegetable colors is recommended. Your risk of cancer may be decreased thanks to the antioxidants in fruits and vegetables.

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